Late reperfusion of an infarct-related coronary artery may improve left ventricular function and survival, though the benefit of opening an occluded artery via angioplasty remains unproven.
Does late reperfusion of an occluded infarct-related coronary artery using angioplasty improve left ventricular function and survival?
The open-artery hypothesis suggests late reperfusion provides benefits beyond myocardial salvage, highlighting the need for randomized trials to evaluate late angioplasty.
Early reperfusion of an infarct-related coronary artery results in myocardial salvage, with subsequent improvement in left ventricular function and survival. However, late reperfusion, which occurs at a time when myocardial salvage is no longer possible, still exerts a favorable impact on left ventricular function and survival. This concept is known as the open-artery hypothesis. Possible mechanisms for this benefit include improved infarct healing, limitation of ventricular remodeling, decreased ventricular arrhythmias, and reperfusion of hibernating myocardium. Although an open infarct-related coronary artery is crucial, it has not been proven that opening an occluded coronary artery using angioplasty is beneficial. A large randomized clinical trial is clearly needed.
Solomon et al. (1998) conducted a review in Myocardial infarction. Late reperfusion (angioplasty) was evaluated. Late reperfusion of an infarct-related coronary artery may improve left ventricular function and survival, though the benefit of opening an occluded artery via angioplasty remains unproven.